Acute aortic dissection is a vascular emergency with unpredictable progression and outcomes. Standard imaging modalities, such as computed tomography angiography (CTA), facilitate diagnosis and operative planning but provide limited data on vessel wall mechanics and hemodynamics. Modern imaging and computational models may offer deeper insights into natural history prognostication and risk prediction. This PROSPERO-registered systematic review (CRD42024589703) followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Eligible MEDLINE and Embase studies assessed vessel wall dynamics or hemodynamic modeling in healthy or dissected aortas. The risk of bias was assessed using Risk Of Bias In Non-Randomized Studies – of Interventions; the quality of evidence was evaluated with Grading of Recommendations, Assessment, Development and Evaluation. A total of 36 studies were included, mainly retrospective single-center cohort studies of CT/CTA, magnetic resonance imaging, ultrasound, echocardiography, and digital subtraction angiography. An entry tear size greater than 10 mm on CTA was associated with increased false lumen flow and higher sheer wall stress, causing poor aortic remodeling, as confirmed with 4-dimensional magnetic resonance imaging. Distal entry tears and presence of more entry tears reduced the risk of pulsatile-type dissections, having a long-term protective effect. Helical flow patterns assessed through computational fluid dynamics determining kinetic energy transmission increase proximal false lumen thrombosis with favorable outcomes. Modern imaging and modeling techniques demonstrate potential in predicting disease progression, with the possibility of tailoring aortic dissection management. Because most studies were exploratory in design, they could not establish replicable clinical protocols or measurable parameters. Measurements of false lumen flow, kinetic energy, and entry tear features (size and number) have demonstrated the greatest potential. Further prospective, standardized studies are essential to translate these findings into routine clinical care.