Image Similarity and Tissue Overlaps as Surrogates for Image Registration Accuracy: Widely Used but Unreliable

The accuracy of nonrigid image registrations is commonly approximated using surrogate measures such as tissue label overlap scores, image similarity, image difference, or transformation inverse consistency error. This paper provides experimental evidence that these measures, even when used in combination, cannot distinguish accurate from inaccurate registrations. To this end, we introduce a "registration" algorithm that generates highly inaccurate image transformations, yet performs extremely well in terms of the surrogate measures. Of the tested criteria, only overlap scores of localized anatomical regions reliably distinguish reasonable from inaccurate registrations, whereas image similarity and tissue overlap do not. We conclude that tissue overlap and image similarity, whether used alone or together, do not provide valid evidence for accurate registrations and should thus not be reported or accepted as such.