In axial-shear strain elastography, the local axial-shear strain resulting from the application of quasi-static axial compression to an inhomogeneous material is imaged. In this paper, we investigated the image quality of the axial-shear strain estimates in terms of the signal-to-noise ratio (SNR asse) and contrast-to-noise ratio (CNRasse) using simulations and experiments. Specifically, we investigated the influence of the system parameters (beamwidth, transducer element pitch and bandwidth), signal processing parameters (correlation window length and axial window shift) and mechanical parameters (Young's modulus contrast, applied axial strain) on the SNRasse and CNRasse. The results of the study show that the CNRasse (SNRasse) is maximum for axial-shear strain values in the range of 0.005-0.03. For the inclusion/background modulus contrast range considered in this study (<10), the CNRasse (SNR asse) is maximum for applied axial compressive strain values in the range of 0.005%-0.03%. This suggests that the RF data acquired during axial elastography can be used to obtain axial-shear strain elastograms, since this range is typically used in axial elastography as well. The CNRasse (SNRasse) remains almost constant with an increase in the beamwidth while it increases as the pitch increases. As expected, the axial shift had only a weak influence on the CNRasse (SNRasse) of the axial-shear strain estimates. We observed that the differential estimates of the axial-shear strain involve a trade-off between the CNRasse (SNR asse) and the spatial resolution only with respect to pitch and not with respect to signal processing parameters. Simulation studies were performed to confirm such an observation. The results demonstrate a trade-off between CNRasse and the resolution with respect to pitch. © 2007 IOP Publishing Ltd.