Handling Commas
For handling commas inside of values when using string.Format(...), the following has worked for me:
var newLine = string.Format("\"{0}\",\"{1}\",\"{2}\"",
                              first,
                              second,
                              third                                    
                              );
csv.AppendLine(newLine);
So to combine it with Johan's answer, it'd look like this:
//before your loop
var csv = new StringBuilder();
//in your loop
  var first = reader[0].ToString();
  var second = image.ToString();
  //Suggestion made by KyleMit
  var newLine = string.Format("\"{0}\",\"{1}\"", first, second);
  csv.AppendLine(newLine);  
//after your loop
File.WriteAllText(filePath, csv.ToString());
Returning CSV File
If you simply wanted to return the file instead of writing it to a location, this is an example of how I accomplished it:
From a Stored Procedure
public FileContentResults DownloadCSV()
{
  // I have a stored procedure that queries the information I need
  SqlConnection thisConnection = new SqlConnection("Data Source=sv12sql;User ID=UI_Readonly;Password=SuperSecure;Initial Catalog=DB_Name;Integrated Security=false");
  SqlCommand queryCommand = new SqlCommand("spc_GetInfoINeed", thisConnection);
  queryCommand.CommandType = CommandType.StoredProcedure;
  StringBuilder sbRtn = new StringBuilder();
  // If you want headers for your file
  var header = string.Format("\"{0}\",\"{1}\",\"{2}\"",
                             "Name",
                             "Address",
                             "Phone Number"
                            );
  sbRtn.AppendLine(header);
  // Open Database Connection
  thisConnection.Open();
  using (SqlDataReader rdr = queryCommand.ExecuteReader())
  {
    while (rdr.Read())
    {
      // rdr["COLUMN NAME"].ToString();
      var queryResults = string.Format("\"{0}\",\"{1}\",\"{2}\"",
                                        rdr["Name"].ToString(),
                                        rdr["Address"}.ToString(),
                                        rdr["Phone Number"].ToString()
                                       );
      sbRtn.AppendLine(queryResults);
    }
  }
  thisConnection.Close();
  return File(new System.Text.UTF8Encoding().GetBytes(sbRtn.ToString()), "text/csv", "FileName.csv");
}
From a List
/* To help illustrate */
public static List<Person> list = new List<Person>();
/* To help illustrate */
public class Person
{
  public string name;
  public string address;
  public string phoneNumber;
}
/* The important part */
public FileContentResults DownloadCSV()
{
  StringBuilder sbRtn = new StringBuilder();
  // If you want headers for your file
  var header = string.Format("\"{0}\",\"{1}\",\"{2}\"",
                             "Name",
                             "Address",
                             "Phone Number"
                            );
  sbRtn.AppendLine(header);
  foreach (var item in list)
  {
      var listResults = string.Format("\"{0}\",\"{1}\",\"{2}\"",
                                        item.name,
                                        item.address,
                                        item.phoneNumber
                                       );
      sbRtn.AppendLine(listResults);
    }
  }
  return File(new System.Text.UTF8Encoding().GetBytes(sbRtn.ToString()), "text/csv", "FileName.csv");
}
Hopefully this is helpful.