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This paper presents an analysis-by-synthesis technique to evaluate the perceptual importance of multimedia packets for rate-distortion optimized streaming. The proposed technique, instead of relying on a priori information, computes the distortion that would be caused by the loss of each single packet, including the effects of error propagation and receiver-side error concealment. A rate-distortion optimized streaming algorithm is presented to compare the perceptual performance obtained using content-adaptive analysis-by-synthesis distortion values versus distortion values obtained using a priori knowledge of the statistical importance of the elements of the compressed multimedia bitstream. Simulations with video test sequences compressed with the MPEG-2 coding standard show that the proposed technique delivers substantial and consistent PSNR gains (1.2-2.8 dB) with respect to ideal frame type-driven a priori distortion evaluation for a wide range of channel conditions. Compared to distortion-agnostic streaming techniques such as SoftARQ, the gain is even more pronounced.