Abstract: To reduce structure blurring and clarity degradation in medical ultrasound images due to acoustic attenuation, we propose a novel adaptive optimization method based on guided filtering. Firstly, the influence of acoustic attenuation for medical image is analyzed.Secondly, the texture information of the image is selected to compensate for the acoustic attenuation after comparison of some ultrasonic pulse-echo compensation methods.Then, due to the edge-preserving and smoothing performance in guided filtering, by combining the mean and variance, it can be used to optimize the regions of structure and speckle noise.High quality ultrasound images with more clinical diagnosis aided information are obtained.The experimental results show that the adaptive method has excellent capability of improving the image clarity, enhancing the structure and reducing the speckle noise.The effect of the proposed method is proved in phantom, in vivo normal and lesion ultrasound images.