I find the claim about image-based development being required for macros somewhat unfounded.

The most trivial counterexample is an interpreter - it can simply evaluate the macros just like ordinary functions.

A step up in complexity is a compiler that - during compilation - compiles macro definitions by emitting code and dynamically loading it (Goo does this http://people.csail.mit.edu/jrb/goo/goo.htm , and I have also put a toy implementation of this together using dlopen, and there are probably many other impls that do this.)