What the check looks for
In a markdown or HTML document, an image without an alt attribute is a mechanical finding: the tag is there and the description is not.
A second pattern is nearly as common and worse than absence: alt text that repeats the filename, the CMS ID or a stock photo caption of no use to anyone.
A third is a missing attribute where an empty one is correct. Decorative images should carry alt="", which a naive rule reports as missing.