Can magnetic resonance imaging scan replace, or triage the use of laparoscopy in establishing diagnosis among women presenting in secondary care with chronic pelvic pain?

Chronic Pelvic Pain (CPP) is defined as pain in the pelvic and lower abdominal region that lasts for 6 months or longer. In primary care, the annual prevalence of CPP is 38/1000 in women aged 15-73, a rate comparable to that of asthma (37/1000) and chronic back pain (41/1000). No effective management policy exists for CPP. At present there is a wide variation in clinical practice concerning diagnosis and management of CPP. This wastes both patients’ time and NHS resources. For example, the diagnosis of endometriosis may be delayed by over 8 years after first presentation with CPP symptoms potentially demoralising the patient and missing the opportunity to improve their quality of life through early effective treatment and may provoke women to seek having a hysterectomy with its inherit risks and consequences. There is a perception that diagnostic laparoscopy, an invasive, expensive and potentially risky procedure, is used far too frequently in the NHS as a significant proportion of patients have no pathology identified. Over 40% of laparoscopies are done solely for the diagnosis of CPP. The aim of this study is to estimate the accuracy of an alternative, non-invasive and cheaper test - Magnetic Resonance Imaging (MRI) scanning - in diagnosing common underlying pathologies causing CPP, and hence the proportion of women who could avoid a laparoscopy with adequate certainty. Three hundred and forty women referred for a diagnostic laparoscopy for CPP will be asked to have a MRI as well. The three main strategies will be compared are: 1. History, examination, ultrasound and laparoscopy 2. MRI scans as an adjunct to laparoscopy 3. MRI as a replacement for laparoscopy