1. 3D Visualization of acoustic neurinomas University of Szeged, Department of Otolaryngology and Head and Neck Surgery University of Szeged, Department of Image Processing and Computer Graphics (1) Sun Microsystems Hungary Ltd. JG Kiss, AL Nagy, J. Jarabin, A. Tanács, A. Czesznak (1), Gy. Smehák, F. Tóth, L. Rovó, J. Jóri 2009

2. Acoustic neurinoma: Complications, therapy Persistent loss of hearing Icreased intracranial pressure Erosion of the auditory canal’s wall Destruction of pons or medulla oblongata Compression of the cerebellum or a nearby nerve Some larger tumours may be supratentorial Therapy: microsurgical, neurosurgical, or stereotaxial irradiation

3. Objectives of our study Comparison of the audiological findings of patients with acoustic neurinoma Investigate possibilities to visualise the objects in 3D Localisation and visualisation of the tumour

4. Patients 10 females, 4 males 10 females, 4 males Age: 47, 15 ± 13 yrs (25-63)‏ Age: 47, 15 ± 13 yrs (25-63)‏ Statistics: Student’s T-test Statistics: Student’s T-test

5. Methods pure tone audimoetry pure tone audimoetry Tympanogram Tympanogram Stapedius-reflex test Stapedius-reflex test DPOAE DPOAE EABR EABR 3D Slicer (volume measurement)‏ 3D Slicer (volume measurement)‏ DP-level Noise level Right side Left side

6. Free Open source Is being actively developed Multiplatform (Solaris (x86, x64), linux (x86, x64), MacOS (x86, ppc), Win32 Intuitive user interface Very responsive and helpful developer community Runs on commodity hardware Website: www.slicer.org Slicer

7. National Institutes of Health National Center for Research Resources National Institute of Biomedical Imaging and Bioengineering National Cancer Institute Telemedicine & Advanced Technology Research Center of the US Army Neuroimaging Analysis Center National Alliance for Medical Image Computing National Center for Image Guided Therapy Biomedical Informatics Research Network Center for Integration of Medicine and Innovative Technology Surgical Planning Laboratory Massachusetts Institute of Technology Johns Hopkins University CISST Georgia Institute of Technology Harvard NeuroDiscovery Center The Martinos Center Massachusetts General Hospital Kitware, Inc. GE Global Research Isomics, Inc. Psychiatric Neuroimaging Laboratory Scientific Computing and Imaging Institute http://slicer.org/pages/Acknowledgments Major Sponsors and Contributors

8. Patient 1 Left side Right side

9. Skull MRI: 16x17x21mm Volume measured with Slicer: 2138 mm 3

10. Patient 2 Right sideLeft side

11. Skull MRI: 10x4x27 mm acoustic neurinoma Volume measured with Slicer 1097mm 3. Volume is actually about half!

12. Patient 3 Right side Left side

13. A 10x8x8 mm neurinoma measured with Slicer: 616 mm 3

14. Patient 4 Acoustic neurinoma and two fronto- temporal arachnoidal cysts

15. Skull MRI: 16x17x21 mm acoustic neurinoma Volume measured with Slicer 1689 mm 3 Cysts: 36582 mm 3 Legend: grey: cerebellum; light green: grey matter; light blue: cysts; dark blue: neurinoma; light yellow: air; yellow: n. VIII; pink: inner ear; orange: eye muscles; green: eyeball

16. Pure tone audiometry of the affected and the non affected side 1 of our patients had profound hearing loss on both ears Standard deviation: 24,3 Standard deviation : 14,3 Affected sideHealthy side

17. Pure tone audiometry on affected and non-affected ears *: p < 0,05 ** * ** *

18. Stapedius-reflex 10 of our patients had no Stapedius-reflex

19. EABR, both sides *: p < 0,05 * * * * * *

20. DP intensity, both ears *: p < 0,05 * * * * * *

21. * ** * * * DP-NF intensity, both ears

22. Conclusion Using Slicer we are able to localize and visualize the exact location and dimensions of the acoustic neurinoma. This can help us to define a more precise prognosis for the patient. With the help of Slicer, the surgical procedure, or the irradiation can be planned very precisely and thus the chances are much higher for a complication-free recovery. During our work we have found significant differences in: In the latencies of all the EABR waves between the affected and the non-affected ears In the IPL of I-III and I-IV/V EABR waves DPOAE: outer hair cell activity between the affected and the non- affected ears Pure tone threshold between the affected and the non-affected ears

23. Thank you for you kind attention!