In this study, we propose an integrated approach based on iterative sliced inverse regression (ISIR) for the segmentation of ultrasound and magnetic resonance (MR) images. The approach integrates two stages. The first is the unsupervised clustering which combines multidimensional scaling (MDS) with K-Means. The dimension reduction based on MDS is employed to obtain fewer representative variates as input variables for K-Means. This step intends to generate the initial group labels of the training data for the second stage of supervised segmentation. We then combine the SIR with the nearest mean classifier (NMC) or the support vector machine (SVM) to iteratively update the group labels for supervised segmentation. The method of SIR is introduced by Li [Sliced inverse regression for dimension reduction. J. Am. Stat. Assoc. 86 (1991) 316–342] to explore the effective dimension reduction (e.d.r.) directions from the training data embedded in high-dimensional space. The test data are then projected onto these directions and the classifiers are further applied to classify the test data. The integrated approach based on ISIR is evaluated on simulated and clinical images, which include ultrasound and MR images. The evaluation results indicate that this approach provides an improvement of image segmentation over the methods to be compared without dimension reduction.