A multiplier-less low complexity reversible integer Karhunen-Lo?ve transform (Low-RKLT) is proposed based on multi-lifting. Conventional methods based on KLT suffer from high computational complexity and unability of applying in lossless medical image compression. To solve the two problems, multiplier-less Low-RKLT is investigated using multi-lifting in this paper. Combined with ROI coding method, we have proposed a progressive lossy-to-lossless ROI compression method for three dimensional (3D) medical images with high performance. In our proposed method Low-RKLT is used for the inter-frame decorrelation after SA-DWT in the spatial domain. Simulation results show that, the proposed method performs much better than 3D-DWT-based method in both lossless and lossy compression.