Clinical value of shear wave elastography (SWE) combined with superb microvascular imaging (SMI) for the evaluation of semen abnormalities.

OBJECTIVE: To investigate the clinical value of shear wave elastography (SWE) and superb microvascular imaging (SMI) in patients with semen abnormalities. METHODS: A total of 150 patients with abnormal semen parameters who were treated at the Reproductive Center of the Affiliated Hospital of Putian University between January 2024 and December 2025 were retrospectively enrolled as the case group. In addition, 100 healthy individuals aged 18-35 were selected as the control group. SWE and SMI examinations were performed in both groups. Testicular volume and semen quality parameters were also measured. The diagnostic performance of SWE and SMI for semen abnormalities was evaluated using receiver operating characteristic (ROC) curve analysis. Spearman correlation analysis and one-way analysis of variance (ANOVA) were used to assess the correlation between SWE/SMI parameters and semen quality. RESULTS: Bilateral testicular shear wave elastography values in the control group were significantly lower than thsoe in the case group (both P<0.05). Bilateral microvascular grading based on SMI was significantly lower in the case group than the control group (χ2=153.344, 160.346, P<0.05). LTSWE was significantly negatively correlated with left testicular volume, sperm concentration, total sperm count, semen volume, and total sperm motility (P<0.05). Right testicular shear wave elastography (RTSWE) was significantly negatively correlated with total sperm motility. The area under the ROC curve (AUC) for LTSWE and RTSWE in diagnosing semen abnormalities was 0.805 and 0.626, respectively, while the combined AUC was 0.814. Left testicular SMI microvascular grading was related to LTSWE, total sperm count, and total sperm motility (P<0.05). Right SMI microvascular grading was associated with RTSWE, sperm concentration, total sperm count, and total sperm motility (P<0.05). The sensitivity and specificity of SMI in diagnosing semen abnormalities were 83.33% and 96.0%, respectively. When combined with TSWE, the sensitivity and specificity increased to 87.33% and 99.0%, respectively. CONCLUSION: SWE and SMI are associated with semen quality parameters and demonstrate diagnostic value for semen abnormalities.