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Nonrigid image registration methods using intensity-based similarity metrics are becoming increasingly common tools to estimate many types of deformations. Nonrigid warps can be very flexible with a large number of parameters and gradient optimization schemes are widely used to estimate them. However, for large datasets, the computation of the gradient of the similarity metric with respect to these many parameters becomes very time consuming. Using a small random subset of image voxels to approximate the gradient can reduce computation time. This work focuses on the use of importance sampling to reduce the variance of this gradient approximation. The proposed importance sampling framework is based on an edge-dependent adaptive sampling distribution designed for use with intensity-based registration algorithms. We compare the performance of registration based on stochastic approximations with and without importance sampling to that using deterministic gradient descent. Empirical results, on simulated magnetic resonance brain data and real computed tomography inhale-exhale lung data from eight subjects, show that a combination of stochastic approximation methods and importance sampling accelerates the registration process while preserving accuracy.