Abstract Generating realistic geometric models from 3D segmented images is an important task in many biomedical applications. Segmented 3D images impose particular challenges for meshing algorithms because they contain multi‐material junctions forming features such as surface patches, edges and corners. The resulting meshes should preserve these features to ensure the visual quality and the mechanical soundness of the models. We present a feature preserving Delaunay refinement algorithm which can be used to generate high‐quality tetrahedral meshes from segmented images. The idea is to explicitly sample corners and edges from the input image and to constrain the Delaunay refinement algorithm to preserve these features in addition to the surface patches. Our experimental results on segmented medical images have shown that, within a few seconds, the algorithm outputs a tetrahedral mesh in which each material is represented as a consistent submesh without gaps and overlaps. The optimization property of the Delaunay triangulation makes these meshes suitable for the purpose of realistic visualization or finite element simulations.