A recent study assessed the performance of spectral CT versus conventional CT for detecting and characterizing communications between the true and false lumen in patients with aortic dissection, using 4D flow MRI as the reference standard. This retrospective analysis included 18 patients with type A or B aortic dissection who had undergone all three imaging modalities. The findings showed that spectral CT detected 69% of the communications identified by 4D flow MRI, compared with 22–33% detected by conventional CT — indicating a nearly twofold increase in diagnostic accuracy for spectral CT in this setting. Notably, spectral CT was often able to identify jet flows in the absence of visible intimal tears, which were missed on conventional CT. Assessment of flow direction was similar between spectral CT and MRI, with most communications exhibiting flow from the true lumen into the false lumen. Overall, spectral CT demonstrated superior performance over conventional CT in identifying and characterizing true–false lumen communications in aortic dissection.