Start with a 3D image stack, it can have multiple time frames, but should be single channel. The image properties need to contain correct pixel dimensions. Then the plugin can be ran.
Once the plugin start there will be two windows: a 3D screen, which should be empty, and a control panel with buttons (described below). Click on the button show volume, and a representation of the image stack should appear in the 3D window. Use the -/+ values to adjust the maximum and minimum cutoffs to improve the display.
The next step would be to create a mesh, this can be accomplished by clicking 'initialize mesh...' A dialog will appear with three orthogonal views of the image. Clicking on one of the views will start creating a sphere, clicking again will finish the sphere. The goal is to contain the desired shape in spheres. The spheres position and radius can be adjusted with the blue handles.
Once the shape is close enough, clicking finish will create a mesh. To have the mesh deform to the image, the parameter "image energy" needs to be adjusted, usually start with a small value around 0.001 and click "deform mesh". The mesh will be attracted to local bright features. If the mesh deforms too much, then click stop, got to the edit menu and select undo. Increase the gamma factor (multiply by 10) and try again. The mesh should deform slower, and hopefully improve.