Ultrasonic backscatter is substantially modified by pathologic changes in myocardium. To define the incidence and significance of increased backscatter in myocardial ultrasonography of patients on chronic hemodialysis, 41 patients (aged 9-63 years) and 20 healthy controls were studied with conventional two-dimensional and M-mode echocardiography and with analysis of integrated backscatter. Increased histogram values were found in all patients especially in those whose two-dimensional echocardiographic examinations revealed mitral annular calcification (n = 3), aortic valve calcification (n = 2) and aortic plus mitral annular calcification (n = 1). It was concluded that ultrasonographic-integrated backscatter may be a useful method for early identification of cardiac calcification in uremic patients.