Abstract: Objective: we evaluated the clinical utility of virtual monoenergetic imaging (VMI) for assessing active Crohn’s disease. Methods: Venous-phase enhanced CT images from 51 subjects were reconstructed and assorted into conventional 120-kVp image and 45-keV VMI image groups. Objective parameters (attenuation values, image noise, signal-to-noise ratio SNR) of bowel walls and vasculature were compared. Two radiologists independently evaluated subjective image quality metrics (noise, contrast, small-structure visibility, and overall quality). Results: The 45-keV VMI group demonstrated significantly enhanced tissue contrast (bowel wall attenuation: 191.3 ± 34.3 HU vs. 86.5 ± 13.9 HU; vascular attenuation: 293.5 ± 67.3 HU vs. 123.9 ± 23.8 HU). Subjective scores for small-structure visibility and overall quality were markedly improved, with maximal visibility scores achieved in 70.6%–92.2% of cases. The 120-kVp group exhibited superior noise control (bowel wall noise: 9.2 ± 3.7 vs. 24.6) and higher SNR (10.2 vs. 78) Vascular SNR showed no significant intergroup difference (12.8 ± 7.8 vs. 111 ± 7.4). Conclusions: By contrast with noise reduction, low-energy VMI (45 keV) more effectively optimized overall image quality in Crohn’s disease evaluation, particularly in scenarios demanding high contrast (e.g., detection of subtle lesions). A combined application approach tailored to specific diagnostic requirements is proposed to refine personalized CT enterography protocols.