diff --git a/demo/markdownlint-browser.js b/demo/markdownlint-browser.js
index 37ff289a..a5fcc78c 100644
--- a/demo/markdownlint-browser.js
+++ b/demo/markdownlint-browser.js
@@ -5834,19 +5834,37 @@ module.exports = {
 
 
 
+function _createForOfIteratorHelper(o, allowArrayLike) { var it = typeof Symbol !== "undefined" && o[Symbol.iterator] || o["@@iterator"]; if (!it) { if (Array.isArray(o) || (it = _unsupportedIterableToArray(o)) || allowArrayLike && o && typeof o.length === "number") { if (it) o = it; var i = 0; var F = function F() {}; return { s: F, n: function n() { if (i >= o.length) return { done: true }; return { done: false, value: o[i++] }; }, e: function e(_e) { throw _e; }, f: F }; } throw new TypeError("Invalid attempt to iterate non-iterable instance.\nIn order to be iterable, non-array objects must have a [Symbol.iterator]() method."); } var normalCompletion = true, didErr = false, err; return { s: function s() { it = it.call(o); }, n: function n() { var step = it.next(); normalCompletion = step.done; return step; }, e: function e(_e2) { didErr = true; err = _e2; }, f: function f() { try { if (!normalCompletion && it["return"] != null) it["return"](); } finally { if (didErr) throw err; } } }; }
+function _unsupportedIterableToArray(o, minLen) { if (!o) return; if (typeof o === "string") return _arrayLikeToArray(o, minLen); var n = Object.prototype.toString.call(o).slice(8, -1); if (n === "Object" && o.constructor) n = o.constructor.name; if (n === "Map" || n === "Set") return Array.from(o); if (n === "Arguments" || /^(?:Ui|I)nt(?:8|16|32)(?:Clamped)?Array$/.test(n)) return _arrayLikeToArray(o, minLen); }
+function _arrayLikeToArray(arr, len) { if (len == null || len > arr.length) len = arr.length; for (var i = 0, arr2 = new Array(len); i < len; i++) arr2[i] = arr[i]; return arr2; }
 var _require = __webpack_require__(/*! ../helpers */ "../helpers/helpers.js"),
-  addError = _require.addError,
-  forEachInlineChild = _require.forEachInlineChild;
+  addError = _require.addError;
+var _require2 = __webpack_require__(/*! ../helpers/micromark.cjs */ "../helpers/micromark.cjs"),
+  filterByTypes = _require2.filterByTypes;
 module.exports = {
   "names": ["MD045", "no-alt-text"],
   "description": "Images should have alternate text (alt text)",
   "tags": ["accessibility", "images"],
   "function": function MD045(params, onError) {
-    forEachInlineChild(params, "image", function forToken(token) {
-      if (token.content === "") {
-        addError(onError, token.lineNumber);
+    var images = filterByTypes(params.parsers.micromark.tokens, ["image"]);
+    var _iterator = _createForOfIteratorHelper(images),
+      _step;
+    try {
+      for (_iterator.s(); !(_step = _iterator.n()).done;) {
+        var image = _step.value;
+        var labelTexts = filterByTypes(image.children, ["labelText"]);
+        if (labelTexts.some(function (labelText) {
+          return labelText.text.length === 0;
+        })) {
+          var range = image.startLine === image.endLine ? [image.startColumn, image.endColumn - image.startColumn] : undefined;
+          addError(onError, image.startLine, undefined, undefined, range);
+        }
       }
-    });
+    } catch (err) {
+      _iterator.e(err);
+    } finally {
+      _iterator.f();
+    }
   }
 };
 
diff --git a/lib/md045.js b/lib/md045.js
index 8d15aedd..891dd165 100644
--- a/lib/md045.js
+++ b/lib/md045.js
@@ -2,17 +2,29 @@
 
 "use strict";
 
-const { addError, forEachInlineChild } = require("../helpers");
+const { addError } = require("../helpers");
+const { filterByTypes } = require("../helpers/micromark.cjs");
 
 module.exports = {
   "names": [ "MD045", "no-alt-text" ],
   "description": "Images should have alternate text (alt text)",
   "tags": [ "accessibility", "images" ],
   "function": function MD045(params, onError) {
-    forEachInlineChild(params, "image", function forToken(token) {
-      if (token.content === "") {
-        addError(onError, token.lineNumber);
+    const images = filterByTypes(params.parsers.micromark.tokens, [ "image" ]);
+    for (const image of images) {
+      const labelTexts = filterByTypes(image.children, [ "labelText" ]);
+      if (labelTexts.some((labelText) => labelText.text.length === 0)) {
+        const range = (image.startLine === image.endLine) ?
+          [ image.startColumn, image.endColumn - image.startColumn ] :
+          undefined;
+        addError(
+          onError,
+          image.startLine,
+          undefined,
+          undefined,
+          range
+        );
       }
-    });
+    }
   }
 };
diff --git a/test/no-alt-text.md b/test/no-alt-text.md
index 768e537c..b685ef8d 100644
--- a/test/no-alt-text.md
+++ b/test/no-alt-text.md
@@ -22,5 +22,11 @@ Link to image with alternate text [![Alternate text](image.jpg)](image.jpg)
 
 Link to image without alternate text [![](image.jpg)](image.jpg) {MD045}
 
+Multi-line image with alternate text ![Alternate text](image.jpg "Title"
+)
+
+Multi-line image without alternate text ![](image.jpg "Title"
+) {MD045:28}
+
 [notitle]: image.jpg
 [title]: image.jpg "Title"
diff --git a/test/snapshots/markdownlint-test-micromark.mjs.snap b/test/snapshots/markdownlint-test-micromark.mjs.snap
index cb3649af..7f03eeb0 100644
Binary files a/test/snapshots/markdownlint-test-micromark.mjs.snap and b/test/snapshots/markdownlint-test-micromark.mjs.snap differ
diff --git a/test/snapshots/markdownlint-test-scenarios.js.md b/test/snapshots/markdownlint-test-scenarios.js.md
index bdde5c41..9be6d9a9 100644
--- a/test/snapshots/markdownlint-test-scenarios.js.md
+++ b/test/snapshots/markdownlint-test-scenarios.js.md
@@ -1860,7 +1860,10 @@ Generated by [AVA](https://avajs.dev).
         {
           errorContext: null,
           errorDetail: null,
-          errorRange: null,
+          errorRange: [
+            33,
+            14,
+          ],
           fixInfo: null,
           lineNumber: 19,
           ruleDescription: 'Images should have alternate text (alt text)',
@@ -6741,7 +6744,10 @@ Generated by [AVA](https://avajs.dev).
         {
           errorContext: null,
           errorDetail: null,
-          errorRange: null,
+          errorRange: [
+            1,
+            14,
+          ],
           fixInfo: null,
           lineNumber: 85,
           ruleDescription: 'Images should have alternate text (alt text)',
@@ -33064,7 +33070,10 @@ Generated by [AVA](https://avajs.dev).
         {
           errorContext: null,
           errorDetail: null,
-          errorRange: null,
+          errorRange: [
+            1,
+            14,
+          ],
           fixInfo: null,
           lineNumber: 5,
           ruleDescription: 'Images should have alternate text (alt text)',
@@ -33077,7 +33086,10 @@ Generated by [AVA](https://avajs.dev).
         {
           errorContext: null,
           errorDetail: null,
-          errorRange: null,
+          errorRange: [
+            1,
+            22,
+          ],
           fixInfo: null,
           lineNumber: 9,
           ruleDescription: 'Images should have alternate text (alt text)',
@@ -33090,7 +33102,10 @@ Generated by [AVA](https://avajs.dev).
         {
           errorContext: null,
           errorDetail: null,
-          errorRange: null,
+          errorRange: [
+            30,
+            14,
+          ],
           fixInfo: null,
           lineNumber: 11,
           ruleDescription: 'Images should have alternate text (alt text)',
@@ -33103,7 +33118,10 @@ Generated by [AVA](https://avajs.dev).
         {
           errorContext: null,
           errorDetail: null,
-          errorRange: null,
+          errorRange: [
+            40,
+            12,
+          ],
           fixInfo: null,
           lineNumber: 15,
           ruleDescription: 'Images should have alternate text (alt text)',
@@ -33116,7 +33134,10 @@ Generated by [AVA](https://avajs.dev).
         {
           errorContext: null,
           errorDetail: null,
-          errorRange: null,
+          errorRange: [
+            50,
+            10,
+          ],
           fixInfo: null,
           lineNumber: 19,
           ruleDescription: 'Images should have alternate text (alt text)',
@@ -33129,7 +33150,10 @@ Generated by [AVA](https://avajs.dev).
         {
           errorContext: null,
           errorDetail: null,
-          errorRange: null,
+          errorRange: [
+            39,
+            14,
+          ],
           fixInfo: null,
           lineNumber: 23,
           ruleDescription: 'Images should have alternate text (alt text)',
@@ -33139,6 +33163,19 @@ Generated by [AVA](https://avajs.dev).
             'no-alt-text',
           ],
         },
+        {
+          errorContext: null,
+          errorDetail: null,
+          errorRange: null,
+          fixInfo: null,
+          lineNumber: 28,
+          ruleDescription: 'Images should have alternate text (alt text)',
+          ruleInformation: 'https://github.com/DavidAnson/markdownlint/blob/v0.0.0/doc/md045.md',
+          ruleNames: [
+            'MD045',
+            'no-alt-text',
+          ],
+        },
       ],
       fixed: `# Images with and without alternate text␊
       ␊
@@ -33164,6 +33201,12 @@ Generated by [AVA](https://avajs.dev).
       ␊
       Link to image without alternate text [![](image.jpg)](image.jpg) {MD045}␊
       ␊
+      Multi-line image with alternate text ![Alternate text](image.jpg "Title"␊
+      )␊
+      ␊
+      Multi-line image without alternate text ![](image.jpg "Title"␊
+      ) {MD045:28}␊
+      ␊
       [notitle]: image.jpg␊
       [title]: image.jpg "Title"␊
       `,
diff --git a/test/snapshots/markdownlint-test-scenarios.js.snap b/test/snapshots/markdownlint-test-scenarios.js.snap
index 47a09967..76ab131c 100644
Binary files a/test/snapshots/markdownlint-test-scenarios.js.snap and b/test/snapshots/markdownlint-test-scenarios.js.snap differ