Display Highest Rated posts WITH images?

You can join wp_ratings table with wp_posts and then loop th posts. This is the code I use (I just copied it from my script). Put in your themes function.php. Then you can use the shortcode [wpb_most_rated] to display Most rated with images. Note that it may or not may work in your particular situation. Hope that helps.

///***** Most Rated articles *****/

function wpb_most_rated_posts() {
// start output buffering
	ob_start();
	?>
	<div class="most-commented">
		<?php
        // Run WP_Query
		global $wpdb;

		$query = '
		    SELECT a.ID, a.post_title, a.guid, b.rating_id, b.rating_postid, b.rating_rating, sum(b.rating_rating)
			FROM
			'. $wpdb->posts .' a INNER JOIN '. $wpdb->ratings .' b ON a.ID = b.rating_postid
			group by
			a.ID
		';

		$results = $wpdb->get_results( $query, OBJECT );

		 if ($results):
		 global $post;
		 foreach ($results as $post):
		 setup_postdata($post); 

        //begin loop
		?>
            <article class="cp-wrap cp-small clearfix">
                <div class="cp-thumb-small">
                    <a href="<?php the_permalink(); ?>" title="<?php the_title_attribute(); ?>"><?php if (has_post_thumbnail()) { the_post_thumbnail('cp-thumb-small'); } else { echo '<img src="' . get_template_directory_uri() . '/images/placeholder-thumb-small.jpg' . '" alt="No Picture" />'; } ?></a>
                </div>
                <p class="entry-meta"><span class="updated"><?php echo get_the_date(); ?></span></p>
                <h3 class="cp-title-small"><a href="<?php the_permalink(); ?>" title="<?php the_title_attribute(); ?>" rel="bookmark"><?php the_title(); ?></a></h3>
                <?php echo do_shortcode( '[ratings results="true"]' ); ?>
                <span class="entry-meta-lower"><?php echo $comments; ?></span>
			</article>
        	<hr class="mh-separator">
        <?php endforeach; ?>
		<?php endif;
        // end loop
        ?>
	</div>
<?php

// Turn off output buffering
$output = ob_get_clean(); 

//Return output
return $output;
}
// Create shortcode
add_shortcode('wpb_most_rated', 'wpb_most_rated_posts'); 

//Enable shortcode execution in text widgets
add_filter('widget_text', 'do_shortcode');

EDIT: Of course you need to use your theme’s html.