Ultrasonic properties of biliary calculi.

The authors show that the intrinsic ultrasonic attenuation of a gallstone is an important factor in determining the degree of shadowing. B scans in vivo and in vitro demonstrated that stones with higher attenuation also show the most shadowing. In addition, attenuation can be correlated with physical structure: more highly attenuating stones tend to have the largest percentage of crystalline material, a larger average crystal size, and a more rigid structure. The authors recommend that higher-frequency transducers be used where possible if nonshadowing structures are seen in the gallbladder.