Structural alterations in fibroelastic components of the penile corpus cavernousum (CC) may impair its compliance,resulting in venous leakage and erectile dysfunction (ED).Our study evaluated the effectiveness of noninvasive two-dimensional shear-wave elastography (2-D SWE) in quantifying penile CC lesions in rabbits with hyperlipidemia-induced ED.A total of 12 New Zealand white rabbits were randomly divided into two groups.Six were fed a high-cholesterol diet containing 2％ cholesterol and 8.5％ lard for 10 weeks and the other six were fed normal diet as controls.We measured the shear-wave elastic quantitative (SWQ) value of penile CC by 2-D SWE.Erectile function was investigated by intracavernous injection of papaverine,and immunohistochemical (IHC) staining and the western blot analysis to determine the penile CC lesions.After 10 weeks,the SWQ values obtained from penile CC were remarkably higher in the high-cholesterol-fed compared with the control group,and the △ICP (ICP plateau minus ICP baseline)/MAP (ICP:intracavernous pressure,MAP:mean arterial pressure) was markedly decreased.The IHC staining and western blot revealed extracellular matrix (ECM) accumulation in penile cavernous tissues,and the smooth muscle cell (SMC) phenotypic transition was affected,as indicated by reduced alpha-smooth muscle actin and calponin-1 expression and increased phospho-myosin light chain20 (p-MLC20)/MLC20 and osteopontin expression.Hyperlipidemia resulted in ECM accumulation accompanied with SMC phenotypic transition in penile CC and impaired the erectile function eventually.These might,in turn,lead to variations in the SWQ values.It suggests that 2-D SWE may be a novel,noninvasive and effective approach that distinguishes penile CC lesions secondary to hyperlipidemia from normal.