u wouldn't - hence my idea of checking to see if embedded images really are images or in fact redirect to some other site - which is what 99% of these spam posts seem to be doing. would only be a few lines of php to do it.
* scan post for any [IMG] tags
* fetch the images - or at least HEAD (contains http headers) - don't store but check that they actually return a mime image type and not just a bunch of redirects that end up at a normal html page etc
* block post if it fails these checks
as for captchas - the old style mangled words and/or numbers are easy to get past using captcha solving services (like death by captcha dot com)
any captcha that *doesnt* just display an image to be solved have a much better chance of being effective - like dripsteps idea. the captcha solving services work on the basis that there is an image that the bot can save and send to the service to be solved and that a simple answer can be entered to solve it.
edit: i really don't mind writing the code to do this - as it's getting bloody annoying i must have flagged at least 4 or 5 posts yesterday just from the threads that i looked at
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