IGF1 and acromegaly: Further advancing this field, an ensemble model integrating multiple predictive features—including (1) preoperative treatment history, (2) MRI characteristics (tumor volume, Knosp grade, and invasiveness), and (3) serum GH and insulin-like growth factor-1 (IGF-1) levels—achieved superior predictive accuracy for endocrine remission in acromegaly (AUC = 0.803) (58).