$re = '/(<img(?!.*?alt=([\'"]).*?\2)[^>]*)(>)/m';
$str = '<html>
<body>
<img src="tos.jpg">
<img src="hfgfg.jpg" alt="texter alternatif">
';
preg_match_all($re, $str, $matches, PREG_SET_ORDER, 0);
// Print the entire match result
var_dump($matches);
Please keep in mind that these code samples are automatically generated and are not guaranteed to work. If you find any syntax errors, feel free to submit a bug report. For a full regex reference for PHP, please visit: http://php.net/manual/en/ref.pcre.php